Kodama K, Doi O, Higashiyama M, Yokouchi H, Tatsuta M
Department of Thoracic Surgery, Center for Adult Diseases, Osaka, Japan.
Cancer. 1993 Jul 15;72(2):426-31. doi: 10.1002/1097-0142(19930715)72:2<426::aid-cncr2820720218>3.0.co;2-s.
To overcome the poor prognosis of lung cancer with pleural dissemination, the authors developed postoperative intrathoracic chemo-thermotherapy (PICT). In this report, they present the long-term results for 31 consecutive patients who underwent resection, followed by PICT for lung cancer with pleural dissemination between April 1985 and December 1991.
Among the patients, there were 26 cases of adenocarcinoma, 3 cases of squamous cell carcinoma, and 1 case each of large and adenosquamous cell carcinoma. Twenty-four of these patients had an initial diagnosis of pleural involvement at thoracotomy. The other seven patients had massive malignant effusion at the time of the initial diagnosis. PICT was started between days 10 to 14 postoperatively. When possible, three courses of this procedure were administered at intervals of 5-7 days.
The 5-year cumulative and 5-year local relapse-free survival rates were 24.6% and 76.3%, respectively. The 3-year and 5-year cumulative survival rates for 14 patients without mediastinal lymph node involvement were 68.4% and 42.7%, respectively. Those rates for 17 patients with mediastinal lymph node involvement were 22.7% and 0%, respectively. The 3-year survival rate in the former group was significantly better than that in the latter group.
These results strongly suggest that in patients with pleural dissemination, PICT may be beneficial for regional disease control and improvement of survival, particularly for patients without mediastinal lymph node involvement.
为克服伴有胸膜播散的肺癌预后不良的问题，作者开展了术后胸腔内化疗热疗（PICT）。在本报告中，他们呈现了1985年4月至1991年12月期间连续31例接受了手术切除并随后接受PICT治疗的伴有胸膜播散的肺癌患者的长期结果。
患者中腺癌26例，鳞状细胞癌3例，大细胞癌和腺鳞癌各1例。其中24例患者在开胸手术时初步诊断为胸膜受累。另外7例患者在初次诊断时出现大量恶性胸腔积液。PICT在术后第10至14天开始。可能的情况下，每隔5 - 7天进行三个疗程的该治疗。
5年累积生存率和5年局部无复发生存率分别为24.6%和76.3%。14例无纵隔淋巴结受累患者的3年和5年累积生存率分别为68.4%和42.7%。17例有纵隔淋巴结受累患者的相应生存率分别为22.7%和0%。前一组的3年生存率显著高于后一组。
这些结果有力地表明，对于伴有胸膜播散的患者，PICT可能有利于区域疾病控制和生存改善，特别是对于无纵隔淋巴结受累的患者。
